{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:38:39Z","timestamp":1793363919008,"version":"4.5.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In order to improve the nutrition and health status of rural school-age children and to reduce malnutrition. This study evaluated the effects of the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIP-RCES) in three counties (Midu, Xuanwei, and Xundian) in Yunnan Province, China, in 2019, 2021, and 2023, and the findings highlight regional differences and future nutrition trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anthropometric indicators (height and weight) and biochemical markers (hemoglobin, Vitamin A, and Vitamin D) were measured and analyzed using linear mixed-effects models to identify temporal changes, regional differences, and the overall effectiveness of the program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The program led to significant improvements in height (<jats:italic>\u03b2<\/jats:italic> =\u202f0.42, <jats:italic>p<\/jats:italic> =\u202f0.013), weight (<jats:italic>\u03b2<\/jats:italic> =\u202f0.66, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.001), and Vitamin A levels (<jats:italic>\u03b2<\/jats:italic> =\u202f0.011, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.001), demonstrating notable progress in physical growth and Vitamin A supplementation. However, hemoglobin levels declined significantly (<jats:italic>\u03b2<\/jats:italic> =\u202f\u22120.38, <jats:italic>p<\/jats:italic> =\u202f0.005), particularly in Xundian, highlighting ongoing challenges in anemia prevention. Vitamin D levels remained stable with no significant improvements (<jats:italic>p<\/jats:italic> =\u202f0.488), possibly influenced by factors such as limited dietary variety and seasonal variations in sun exposure. Additionally, considerable disparities in program outcomes were observed among counties, with Midu generally showing superior improvements compared to Xuanwei and Xundian.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While the NNIP-RCES effectively enhanced physical growth and alleviated Vitamin A deficiency, persistent anemia, unchanged Vitamin D levels, and marked regional disparities underscore critical areas requiring further attention. Future policy refinements should focus on targeted interventions addressing anemia prevention, Vitamin D supplementation, enhanced dietary diversity, and equitable resource allocation across regions. Strengthened monitoring frameworks and comprehensive nutrition education initiatives are also recommended to ensure sustainable improvements and serve as a model for global school-based nutritional interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1585735","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T04:10:41Z","timestamp":1748232641000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating the student nutrition improvement program: regional disparities and nutritional trends in Yunnan, China (2019\u20132023)"],"prefix":"10.3389","volume":"13","author":[{"given":"Fang","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Litao","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S0140-6736(07)60076-2","article-title":"Child development: risk factors for adverse outcomes in developing countries","volume":"369","author":"Walker","year":"2007","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1093\/bmb\/ldaa034","article-title":"Meeting the challenges of micronutrient malnutrition in the developing world","volume":"136","author":"Bhutta","year":"2020","journal-title":"Br Med Bull"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1051810","DOI":"10.3389\/fpubh.2022.1051810","article-title":"Nutrition improvement program for rural compulsory education students and individual health","volume":"10","author":"Liang","year":"2022","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4113","DOI":"10.3390\/nu13114113","article-title":"School-based nutrition interventions in children aged 6 to 18 years: an umbrella review of systematic reviews","volume":"13","author":"O\u2019Brien","year":"2021","journal-title":"Nutrients"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.gfs.2018.08.003","article-title":"Concepts and critical perspectives for food environment research: a global framework with implications for action in low- and middle-income countries","volume":"18","author":"Turner","year":"2018","journal-title":"Glob Food Sec"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/ageing\/afu104","article-title":"Understanding vitamin D deficiency","volume":"43","author":"Sahota","year":"2014","journal-title":"Age Ageing"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2592","DOI":"10.1093\/jn\/134.10.2592","article-title":"Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 meta-analyses","volume":"134","author":"Ramakrishnan","year":"2004","journal-title":"J Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/bmb\/ldt015","article-title":"Meeting the challenges of micronutrient malnutrition in the developing world","volume":"106","author":"Bhutta","year":"2013","journal-title":"Br Med Bull"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s13643-020-01360-3","article-title":"The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression","volume":"9","author":"Al Khalifah","year":"2020","journal-title":"Syst Rev"},{"key":"ref10","unstructured":"2014"},{"key":"ref11","unstructured":"2018"},{"key":"ref12","unstructured":"School-based nutrition programs to improve child health in India\n          \n          \n            \n              Kremer\n              M\n            \n            \n              Duflo\n              E\n            \n            \n              Banerjee\n              A\n            \n            \n              Glennerster\n              R\n            \n            \n              Khemani\n              S\n            \n            \n              Singh\n              A\n            \n          \n          \n          2021"},{"key":"ref13","article-title":"Food4Education: scaling up school feeding in Kenya","author":"Njiru","year":"2024"},{"key":"ref14","unstructured":"World Health Organization\n          Addressing health inequities among people living in rural and remote areas\n          \n          2021"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1585735\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T04:10:43Z","timestamp":1748232643000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1585735\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":14,"alternative-id":["10.3389\/fpubh.2025.1585735"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1585735","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]},"article-number":"1585735"}}